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Michalczyk J, Miłosz A, Soroka E. Postpartum Psychosis: A Review of Risk Factors, Clinical Picture, Management, Prevention, and Psychosocial Determinants. Med Sci Monit 2023; 29:e942520. [PMID: 38155489 PMCID: PMC10759251 DOI: 10.12659/msm.942520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/11/2023] [Indexed: 12/30/2023] Open
Abstract
Postpartum psychosis is rare, but is a serious clinical and social problem. On its own, it is not included in DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) or ICD-10 (International Statistical Classification of Diseases and Related Health Problems) as a disease entity, and current diagnostic criteria equate it with other psychoses. This poses a serious legal problem and makes it difficult to classify. The disorder is caused by a complex combination of biological, environmental, and cultural factors. The exact pathophysiological mechanisms of postpartum psychosis remain very poorly understood. There is a need for further research and increased knowledge of the medical sector in the prevention and early detection of psychosis to prevent stigmatization of female patients during a psychiatric episode. It is necessary to regulate its position in the DSM5 and ICD-10. Attention should be paid to the social education of expectant mothers and their families. This article aims to review the current status of risk factors, prevention, and management of postpartum psychosis.
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Affiliation(s)
- Justyna Michalczyk
- II Department of Psychiatry and Psychiatric Rehabilitation, Student Scientific Association, Faculty of Medicine, Medical University of Lublin, Lublin, Poland
| | - Agata Miłosz
- II Department of Psychiatry and Psychiatric Rehabilitation, Student Scientific Association, Faculty of Medicine, Medical University of Lublin, Lublin, Poland
| | - Ewelina Soroka
- II Department of Psychiatry and Psychiatric Rehabilitation, Medical University of Lublin, Lublin, Poland
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Masters GA, Hugunin J, Xu L, Ulbricht CM, Moore Simas TA, Ko JY, Byatt N. Prevalence of Bipolar Disorder in Perinatal Women: A Systematic Review and Meta-Analysis. J Clin Psychiatry 2022; 83:21r14045. [PMID: 35830616 PMCID: PMC10849873 DOI: 10.4088/jcp.21r14045] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: To estimate overall prevalence of bipolar disorder (BD) and the prevalence and timing of bipolar-spectrum mood episodes in perinatal women. Data Sources: Databases (PubMed, Scopus, PsycINFO, CINAHL, Cochrane, ClincalTrials.gov) were searched from inception to March 2020. Study Selection: Included studies were original research in English that had (1) populations of perinatal participants (pregnant or within 12 months postpartum), aged ≥ 18 years, and (2) a screening/diagnostic tool for BD. Search terms described the population (eg, perinatal), illness (eg, bipolar disorder), and detection (eg, screen, identify). Data Extraction: Study design data, rates, and timing of positive screens/diagnoses and mood episodes were extracted by 3 independent reviewers. Pooled prevalences were estimated using random-effects meta-analyses. Results: Twenty-two articles were included in qualitative review and 12 in the meta-analysis. In women with no known psychiatric illness preceding the perinatal period, pooled prevalence of BD was 2.6% (95% CI, 1.2%-4.5%) and prevalence of bipolar-spectrum mood episodes (including depressed, hypomanic/manic, mixed) during pregnancy and the postpartum period was 20.1% (95% CI, 16.0%-24.5%). In women with a prior BD diagnosis, 54.9% (95% CI, 39.2%-70.2%) were found to have at least one bipolar-spectrum mood episode occurrence in the perinatal period. Conclusions: Our review suggests that the perinatal period is associated with high rates of bipolar-spectrum mood episodes and that pregnant and postpartum women represent a special risk population. This review may help to inform clinical care recommendations, thus helping to identify those who may have.
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Affiliation(s)
- Grace A Masters
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
- Corresponding author: Grace A. Masters, BS, University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA 01605 (; ORCID ID: https://orcid.org/0000-0001-6064-3786)
| | - Julie Hugunin
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Lulu Xu
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Christine M Ulbricht
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
- Now with National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | | | - Jean Y Ko
- Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service Commissioned Corps, Rockville, Maryland
| | - Nancy Byatt
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
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Verma V, Randhawa A, Chaudhary N, Brar MS, Munder S. A community-based cross-sectional study to assess the prevalence of post-partum depression: Why are the mothers depressed? J Family Med Prim Care 2021; 10:4536-4541. [PMID: 35280603 PMCID: PMC8884330 DOI: 10.4103/jfmpc.jfmpc_2532_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 06/11/2021] [Accepted: 06/20/2021] [Indexed: 11/07/2022] Open
Abstract
Introduction: Post-partum depression can have adverse long term effects. For the mother, the episode can be the precursor of chronic recurrent depression. For her children her on going depression can contribute to emotional, cognitive and interpersonal problems in their later life. In the present study, we aimed to identify the incidence of depression in post-partum period and explore the underlying etiological factors responsible for the same. Materials and Methods: A cross sectional study was conducted on 250 post- natal mothers covered under UHTC, Tripuri, Patiala. The data collection was done through one to one interview technique with mental evaluation done by Edinburgh Postnatal Depression Scale instrument. Based upon the results, the cases were classified either as normal or presence of psychiatric morbidity. Psychiatry referral was provided to those requiring it. Association of post-partum depression with various socio-demographic and medical correlates was then sought through statistical analysis. Results: Post-partum depression was observed in 82 out of 250 females (32.8%). On univariable analysis family income, illiteracy, history of depression, caesarean section, death in family, were significantly associated with post-partum depression. On multi-variable analysis, poverty, female gender of baby, domestic violence and were observed as true predictors of depression in post-partum period (p<0.05). Conclusion: Depression was prevalent among almost one-third of postnatal females. Poverty, Cesarean section, domestic violence and poor spousal support have been identified as major contributors towards psychiatric morbidities. Taking care of these largely modifiable risk factors can prevent development of postpartum depression.
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Pranal M, Legrand A, de Chazeron I, Llorca PM, Vendittelli F. Prevalence of maternal psychological disorders after immediate postpartum haemorrhage: a repeated cross-sectional study - the PSYCHE* study protoco. BMJ Open 2019; 9:e027390. [PMID: 31488469 PMCID: PMC6731911 DOI: 10.1136/bmjopen-2018-027390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The main objective of this study is to assess the prevalence of depression at 2, 6 and 12 months postpartum in women who have had an immediate postpartum haemorrhage (PPH) (blood loss ≥500 mL within 24 hours of delivery). The secondary objectives are to assess the prevalence of anxiety and post-traumatic stress disorder among these women and to evaluate the prevalence of psychological disorders according to the severity of the PPH. METHODS AND ANALYSIS This repeated, cross-sectional, single-centre study will take place at the Clermont-Ferrand University Hospital (France). The population will comprise a cohort of women giving birth at a term ≥22 weeks of gestation.For each woman with a PPH (exposed), two women without PPH (unexposed) will be included: the women who give birth immediately before and immediately after her. The PPH will be managed according to French guidelines. The principal endpoint is the prevalence of depression, measured by the Edinburgh Postnatal Depression Scale (EPDS). The intervention will consist of four surveys including various self-completed questionnaires: the first during the immediate postpartum (Post-Delivery Perceived Stress Inventory (PDPSI), Spielberger'sState-Trait Anxiety Inventory (STAI)-Y-A and Y-B and Mini-International Neuropsychiatric Interview (M.I.N.I.) 5.0.0), then at 2 months (EPDS, STAI-Y-A, Generalised Anxiety Disorder (GAD-7) and Revised Impact of Event Scale (IES-R)), and finally at 6 months and 1 year postpartum (EPDS, STAI-Y-A, GAD-7, M.I.N.I. 5.0.0 and IES-R). The study will include 1542 women - 514 with PPH. ETHICS AND DISSEMINATION The institutional review board (IRB) approved the study on 14 February 2017 (IRB Sud Est VI: N°AU1243).Results will be reported in peer-reviewed journals and at scientific meetings. Findings from the study will be useful for individualising medical follow-up after childbirth, especially for woman who experienced a PPH, but also more generally in increasing birth professionals' awareness of effects of trauma. The evidence obtained might also lead to modifying practices and including this recommendation in French guidelines on PPH. TRIAL REGISTRATION NUMBER NCT03120208.
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MESH Headings
- Adult
- Anxiety/diagnosis
- Anxiety/epidemiology
- Anxiety/etiology
- Anxiety/physiopathology
- Cross-Sectional Studies
- Delivery, Obstetric/adverse effects
- Delivery, Obstetric/methods
- Delivery, Obstetric/statistics & numerical data
- Depression, Postpartum/diagnosis
- Depression, Postpartum/epidemiology
- Depression, Postpartum/etiology
- Depression, Postpartum/physiopathology
- Female
- France/epidemiology
- Humans
- Parturition/psychology
- Postpartum Hemorrhage/diagnosis
- Postpartum Hemorrhage/psychology
- Prevalence
- Psychiatric Status Rating Scales
- Stress Disorders, Post-Traumatic/diagnosis
- Stress Disorders, Post-Traumatic/epidemiology
- Stress Disorders, Post-Traumatic/etiology
- Stress Disorders, Post-Traumatic/physiopathology
- Time Factors
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Affiliation(s)
- Marine Pranal
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
- UniversitéClermont-Auvergne, CHU Clermont-Ferrand, CNRS,SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Anne Legrand
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
- UniversitéClermont-Auvergne, CHU Clermont-Ferrand, CNRS,SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Ingrid de Chazeron
- Psychiatry B, CHU Clermont-Ferrand, Clermont-Ferrand, France
- UFR Medecine, EA7280, Univ Clermont 1, Clermont-Ferrand, France
| | - Pierre-Michel Llorca
- Psychiatry B, CHU Clermont-Ferrand, Clermont-Ferrand, France
- UFR Medecine, EA7280, Univ Clermont 1, Clermont-Ferrand, France
| | - Françoise Vendittelli
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
- UniversitéClermont-Auvergne, CHU Clermont-Ferrand, CNRS,SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
- The AUDIPOG Sentinel Network (Association des Utilisateurs de Dossiers informatisés en Pédiatrie, Obstétrique et Gynécologie), RTH Laennec Medical University, Lyon, France
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Gilmoor AR, Adithy A, Regeer B. The Cross-Cultural Validity of Post-Traumatic Stress Disorder and Post-Traumatic Stress Symptoms in the Indian Context: A Systematic Search and Review. Front Psychiatry 2019; 10:439. [PMID: 31333512 PMCID: PMC6620607 DOI: 10.3389/fpsyt.2019.00439] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 06/03/2019] [Indexed: 02/02/2023] Open
Abstract
Background: The cross-cultural validity of the construct of post-traumatic stress disorder (PTSD) has been a life-long debate in the field of trauma. Its validation in a setting such as India-a nation prone to considerably traumatic events such as conflict, natural disasters, and sexual violence against women-warrants exploration. Objective: To describe how PTSD and post-traumatic stress symptoms (PTSS) are conceptualized in the Indian context by systematically examining the evidence of studies that investigate PTSD and PTSS in India. Methods: A systematic search in PubMed, Web of Science, and Science Direct yielded a total of 56 studies that discussed one or multiple aspects of PTSD and PTSS in India. Data relating to types of events, populations, diagnostic tools, manifestations, and interventions were extracted and analyzed. Results: Eleven of 29 Indian states and 2/7 union territories were represented in the 56 included studies, with most studies (n = 21) originating from Tamil Nadu. Natural Disasters (n = 28), War/Conflict (n = 10), and Medical conditions (n = 7) were the top three most commonly investigated traumatic events. The majority of studies focused on entire communities (n = 16), while children and adolescents made up the second largest group (n = 14). Less attention was paid explicitly to male (n = 3) or female (n = 4) victims. Twenty-five different methods for screening for PTSD were identified, with the most common being the impact of events scale (n = 14). The majority of studies reported the screening and clinical diagnosis of PTSD by professional health care providers (n = 24). Abuse scored the highest average prevalence of PTSD at 52.3%, while the lowest was 16.4% due to man-made accidents. Overall, there was a lack of assessment on trauma-specific interventions, though psychosocial support was the most commonly mentioned intervention. Conclusions: Results indicate diversity in approaches for identifying, measuring, and treating PTSD and PTSS in the Indian population and how sociocultural norms influence its manifestation in this population. Future research calls for the development of culturally sensitive approaches to identifying and addressing PTSD and PTSS in India.
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Affiliation(s)
- Andrew Roderick Gilmoor
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University Amsterdam, Amsterdam, Netherlands
| | | | - Barbara Regeer
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University Amsterdam, Amsterdam, Netherlands
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Guida JP, Costa ML, Parpinelli MA, Pacagnella RC, Ferreira EC, Mayrink J, Silveira C, Souza RT, Sousa MH, Say L, Chou D, Filippi V, Barreix M, Barbour K, McCaw-Binns A, von Dadelszen P, Cecatti JG. The impact of hypertension, hemorrhage, and other maternal morbidities on functioning in the postpartum period as assessed by the WHODAS 2.0 36-item tool. Int J Gynaecol Obstet 2018; 141 Suppl 1:55-60. [PMID: 29851117 PMCID: PMC6001578 DOI: 10.1002/ijgo.12467] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To assess the scores of postpartum women using the WHO Disability Assessment Schedule 2.0 36‐item tool (WHODAS‐36), considering different morbidities. Methods Secondary analysis of a retrospective cohort of women who delivered at a referral maternity in Brazil and were classified with and without severe maternal morbidity (SMM). WHODAS‐36 was used to assess functioning in postpartum women. Percentile distribution of total WHODAS score was compared across three groups: Percentile (P)<10, 10<P<90, and P>90. Cases of SMM were categorized and WHODAS‐36 score was assessed according to hypertension, hemorrhage, or other conditions. Results A total of 638 women were enrolled: 64 had mean scores below P<10 (1.09) and 66 were above P>90 (41.3). Of women scoring above P>90, those with morbidity had a higher mean score than those without (44.6% vs 36.8%, P=0.879). Women with higher WHODAS‐36 scores presented more complications during pregnancy, especially hypertension (47.0% vs 37.5%, P=0.09). Mean scores among women with any complication were higher than those with no morbidity (19.0 vs 14.2, P=0.01). WHODAS‐36 scores were higher among women with hypertensive complications (19.9 vs 16.0, P=0.004), but lower among those with hemorrhagic complications (13.8 vs 17.7, P=0.09). Conclusions Complications during pregnancy, childbirth, and the puerperium increase long‐term WHODAS‐36 scores, demonstrating a persistent impact on functioning among women, up to 5 years postpartum. Women who experienced severe maternal morbidity are at risk of disabilities in the postpartum period, as measured by the WHODAS 2.0 36‐item tool.
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Affiliation(s)
- José P Guida
- Department of Obstetrics and Gynecology, University of Campinas, São Paulo, Brazil
| | - Maria L Costa
- Department of Obstetrics and Gynecology, University of Campinas, São Paulo, Brazil
| | - Mary A Parpinelli
- Department of Obstetrics and Gynecology, University of Campinas, São Paulo, Brazil
| | - Rodolfo C Pacagnella
- Department of Obstetrics and Gynecology, University of Campinas, São Paulo, Brazil
| | - Elton C Ferreira
- Department of Obstetrics and Gynecology, University of Campinas, São Paulo, Brazil
| | - Jussara Mayrink
- Department of Obstetrics and Gynecology, University of Campinas, São Paulo, Brazil
| | - Carla Silveira
- Department of Obstetrics and Gynecology, University of Campinas, São Paulo, Brazil
| | - Renato T Souza
- Department of Obstetrics and Gynecology, University of Campinas, São Paulo, Brazil
| | - Maria H Sousa
- Department of Obstetrics and Gynecology, University of Campinas, São Paulo, Brazil
| | - Lale Say
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Doris Chou
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Veronique Filippi
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Maria Barreix
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Kelli Barbour
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Affette McCaw-Binns
- Department of Community Health and Psychiatry, University of the West Indies, Mona, Kingston, Jamaica
| | - Peter von Dadelszen
- Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - José G Cecatti
- Department of Obstetrics and Gynecology, University of Campinas, São Paulo, Brazil
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Zaidi F, Nigam A, Anjum R, Agarwalla R. Postpartum Depression in Women: A Risk Factor Analysis. J Clin Diagn Res 2017; 11:QC13-QC16. [PMID: 28969212 DOI: 10.7860/jcdr/2017/25480.10479] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 06/20/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Postpartum Depression (PPD) is a known entity affecting not only the women but the whole family. It affects women more harshly and chronically due to their increased stress sensitivity, maladaptive coping strategies and multiple social roles in the community. AIM To estimate the commonly associated risk factors of PPD among the women coming to a tertiary hospital in New Delhi, India. MATERIALS AND METHODS It was a longitudinal study conducted at the antenatal clinic for a period of one year. Total 260 women were screened at > 36 weeks of gestation, of which 149 postnatal women completed the questionnaire for PPD at six weeks of their delivery. The inform consent, demographical data and obstetrical details from each participant was taken before commencing the screening. Various risk factors and their association were determined by odds-ratio and significant association was accepted at < 5% level of error. In order to identify the most important confounding variables, logistic regression analysis was used. RESULTS PPD is a common mental health problem seen among the postnatal women as it was found in 12.75% (19 out of 149) of subjects at six weeks of their delivery. Moreover, it has significant association with the young maternal age (p-value=0.040), birth of the female child (p-value=0.015), previous stressful life events (p-value= 0.003), low self-esteem and feeling of loneliness (p-value=0.007). CONCLUSION This study provides important information regarding the risk factors associated with development of PPD in this region of India. Female sex of the new born and the younger age play an important role in the development of PPD.
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Affiliation(s)
- Farheen Zaidi
- Postgraduate Student, Department of Preventive and Social Medicine, Faculty of Medicine (Unani), Jamia Hamdard, New Delhi, India
| | - Aruna Nigam
- Professor, Department of Obstetrics and Gynaecology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Ruby Anjum
- Assistant Professor, Department of Preventive and Social Medicine, Faculty of Medicine (Unani), Jamia Hamdard, New Delhi, India
| | - Rashmi Agarwalla
- Assistant Professor, Department of Preventive and Social Medicine, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
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